The White House Conference on Aging (WHCoA) is a conference sponsored by the Executive Office of the President of the United States which makes policy recommendations to the president and Congress regarding the aged. The goals of the conference are to promote the dignity, health and economic security of older Americans. It has been claimed that it is perhaps the best-known White House conference. The Conference is held once a decade, with the most recent conference held in earlier this month on July 13th at the White House.

Historically, in 1950, President Harry S. Truman ordered the Federal Security Agency to hold the first national conference on aging. The purpose of this initial conference was to assess the policy challenges posed by a changing populace, particularly in light of numerous changes in federal entitlement programs (such as Social Security) that had been enacted during the previous 20 years. Social Security’s goal was to assist those in need of financial assistance such as the poor, elderly, physically disabled or mentally ill.

In preparation for this decade’s conference, there were five regional conferences around the country purposed to aggregate information and recommendations for the national conference at the White House.

I was fortunate enough to receive an invitation to participate in the Cleveland, Ohio regional conference. Select this link to read about the Cleveland Regional WHCoA conference. In addition, I wrote a blog recommendation that I’ll share at a later date. From these five regional sessions, together with input from other aging leaders and older Americans around the country, common themes were identified and developed into major topic areas. Those topic areas are the following.

Retirement security is a vitally important issue. Financial security in retirement provides essential peace of mind for older Americans, but requires attention during our working lives to ensure that we are well prepared for retirement.

Healthy aging will be all the more important as baby boomers age. As medical advances progress, the opportunities for older Americans to maintain their health and vitality should progress as well and community supports, including housing, are important tools to promote this vitality.

Long-term services and supports remain a priority. Older Americans overwhelmingly prefer to remain independent in the community as they age. They need supports to do so, including a caregiving network and well-supported workforce.

Elder justice is important given that seniors, particularly the oldest older Americans, can be vulnerable to financial exploitation, abuse, and neglect. The Elder Justice Act was enacted as part of the Affordable Care Act, and we need to realize its vision of protecting seniors from scam artists and others seeking to take advantage of them.

In an era where cooperation in Washington is not very good, I commend President Obama for moving forward and continuing this historically important White House forum. Additionally, several Congressional representatives were in attendance throughout the day. With the sheer number of aging Americans, this is a defining time for issues regarding the health and well-being of our seniors to be aired, understood, and appropriately actioned. The entire country is being impacted. The issues of aging are important to every American, not just our elderly citizens.

Conference Outcomes

The 2015 White House Conference on Aging was an opportunity to highlight the importance of supporting the aging population in the United States. President Obama became the first president to discuss elder abuse in public in a speech at this Conference. The Administration announced a number of key deliverables to help empower Americans as they age.

OLDER AMERICANS ACT (OAA)
It is worth noting that just after the WHCoA, the critical and politically contentious, reauthorization of the Older Americans Act (S. 192), was passed by a bipartisan action of the Senate on July 16th. The Older Americans Act of 1965 was the first federal level initiative aimed at providing comprehensive services for older adults. It created the National Aging Network comprising the Administration on Aging on the federal level, State Units on Aging, and Area Agencies on Aging at the local level. The network provides funding – based primarily on the percentage of an area’s population 60 and older – for nutrition and supportive home and community-based services, disease prevention/health promotion services, elder rights programs, the National Family Caregiver Support Program, and the Native American Caregiver Support Program. Since it was enacted into law in 1965, millions of our most vulnerable older Americans have relied on the services provided by the OAA for their health and economic security. These services help older Americans live independently by:

Supporting nutrition programs, including Meals-on-Wheels;

Providing home and community-based services, including preventive health services and transportation assistance;

Assisting family caregivers with information and referral, counseling and respite care;

Preventing and detecting elder abuse; and

Providing part-time community service employment and training, including the Senior Community Employment Program (SCSEP), which has helped more than 1 million older Americans enter the workforce.

Reauthorization of the Older Americans Act is critical to the health and well-being of millions of our seniors throughout the country. It is my hope that the House will also be led to vote and approve OAA reauthorization before they recess in August. These program are essential to the millions of people who helped to build our country.

I’m writing this post from Chicago where I have the pleasure of joining over 3000 professionals in the field of aging all in attendance at the 2015 Aging in America Conference (AiA15) sponsored by the American Society on Aging. We have over 500 workshops, National Forums, symposia and other sessions all focused on the subject of ‘aging’, taking place over 5 days at the Hyatt Regency hotel.

At this year’s conference, I’ve been particularly interested in the policy sessions that have taken place. These sessions will assist me in my role as an advocate for aging related issues when I visit with representatives and senators in our state capital and in our nations capital.

One trend I’ve noted at several sessions is a transition in clinical modeling to a “patient-centered” approach. There can be a broad interpretation regarding this term. From Wikipedia, care that is defined as “patient-centered”, supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. The Institute of Medicine defines patient-centered care as: “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design. Given that non-consumer stakeholders often don’t know what matters most to patients regarding their ability to get well and stay well, care that is truly patient-centered cannot be achieved without active patient engagement at every level of care design and implementation.

Generally speaking, patients should no longer be simply signing off on a doctor’s order. The patient is to be consulted and counseled through every phase of their care. This is a much more time intensive process on the part of the medical profession. Because of that, patient-centered care may be difficult to realize in regular practice.

WHITE HOUSE CONFERENCE ON AGING — JULY 2015

The White House Conference on Aging (WHCoA) is a once-a-decade conference sponsored by the Executive Office of the President of the United States which makes policy recommendations to the president and Congress regarding the aged. The goals of the conference are to promote the dignity, health and economic security of older Americans. It has been claimed that it is perhaps the best-known White House conference. The Conference is held once a decade, with the most recent conference held in 2005, in preparation for the retirement of the baby boomer generation.

In July of this year, the White House is convening this decades WHCoA. I had the opportunity to sit in on several sessions at AIA15 focused on the WHCoA including one with Ms. Nora Super, who is the Executive Director of the 2015 White House Conference on Aging. Ms. Super assured us that President Obama will be in attendance at the July conference.

Additionally, I’m privileged to have been invited to attend an invitation-only ‘issues forum’ sponsored by the Benjamin Rose Institute on Aging (BRIA) in April. Our input will be provided to one of only five pre-conference regional forums held around the nation. Fortunately for us in Ohio, the fifth regional meeting has been scheduled in Cleveland for Monday, April 27.

Given the significance of this historic year (50th anniversary of Medicare, Medicaid, the Older Americans Act, the 80th anniversary of Social Security), it is incumbent on aging advocates everywhere to take note of the WHCoA in July, and assure that our thoughts about the future of aging and aging services in America are heard.

Is there no let up to the cold and snow of this winter of 2014-2015? Very few areas in the country have been spared from the frigid onslaught. Further, I can pretty safely say that most of us are very tired of it and ready for the relief that comes with spring. In the meantime, we have a responsibility to help our seniors keep safe and warm.

Did you know that as we age, our ability to adapt to extreme weather conditions changes. Our bodies tend to lose body heat more quickly and we are more likely to take medications that affect our ability to regulate internal body temperature, making us more susceptible to cold weather. This fact plays a physiological role in the mentality of so many people this time of year; the thought that every winter seems to be more difficult on us than the last!

To help you and your loved ones stay warm safely this winter, The Ohio Department of Aging has partnered with the Public Utilities Commission of Ohio (PUCO) to share these safe heating tips:

Have your furnace, vents, flues and chimneys inspected once a year by a qualified repair person.

Plug portable space heaters directly into an outlet (not an extension cord) at least three feet from anything that can burn, such as paper, bedding and people. Look for models that have an automatic shut-off.

Install or replace batteries of carbon monoxide detectors and smoke alarms and test to make sure they work.

Never use an oven to heat the house. This can damage the oven and possibly cause carbon monoxide poisoning in the home.

Leave the house immediately and call 911 if carbon monoxide is detected or you suspect a gas leak. Carbon monoxide poisoning creates flu-like symptoms and can cause extreme illness or death. Signs of a gas leak include a rotten egg or sulfur-like odor.Heating Assistance Programs
For many, the cost of heating their homes can be a concern, and some face the possibility of having their heating source disconnected or running out of heating fuel when they need it most. For these individuals, the Ohio Development Services Agency’s Winter Crisis Program may be able to help. It provides assistance to eligible households at or below 175 percent of the federal poverty guidelines to avoid disconnection, get their utility reconnected or get a supply of heating fuel. Call 1-800-282-0880 during regular business hours, or visit www.energyhelp.ohio.gov for more information.Another resource, Ohio’s Winter Reconnect Order Program, allows residential customers, regardless of income, to have their utility service restored or maintained by paying the amount due or $175, whichever is less. If the service has already been disconnected, the customer must pay the $175 and possibly a reconnection fee of no more than $36 to restore service. Customers may use the program once during this winter’s heating season through April 15, 2015. Call the PUCO at 1-800-686-7826 for more information about this and other programs, as well as natural gas safety. Visit www.winterheat.ohio.gov for additional ways to save on home heating bills.If you or an older friend or loved one needs help to remain safely at home any time of the year, contact your area agency on aging for available services, supports and resources. Call 1-866-243-5678 to be connected to the agency serving your community.If you are warm and safe, take a moment to call or visit an older loved one or neighbor to ensure they have what they need to beat another Ohio winter.

One question we are asked consistently by people inquiring about our services is “Does Medicare Insurance pay for custodial (private duty) home care services”? Custodial in-home care is also referred to as “private duty” home care.

Custodial Care or Private Duty Home Care is non-medical care that helps individuals with his or her activities of daily living, preparation of special diets and self-administration of medication not requiring constant attention of medical personnel. Providers of custodial care are not required to undergo medical training. Therefore, ‘custodial care’ or ‘private duty’ home care, the care that provides the ‘activities of daily living’ and enables seniors to ‘age-in-place’ (usually their home) is often referred to as “non-medical” care.

It occurred to me that I have not created a blog post focused on the role of Medicare as it pertains to private-duty home care for seniors. So, with a few necessary definitions provided along the way, here goes.

First, let’s understand that Medicare insurance is a complex subject. Medicare was established by the federal government because at the time, most private insurers would not sell health insurance policies to older adults. From Wikipedia, “Medicare is a national social insurance program, administered by the U.S. federal government since 1965, currently using about 30 private insurance companies across the United States. Medicare was established by the federal government to care for a very vulnerable part of our population. However, private insurance companies execute the health insurance program.

Medicare guarantees access to health insurance for Americans aged 65 and older who have worked and paid into the system, and younger people with disabilities as well as people with end stage renal disease (Medicare.gov, 2012) and persons with amyotrophic lateral sclerosis. As a social insurance program, Medicare spreads the financial risk associated with illness across society, even to people who cannot use it and may never want it or use it, and thus has a somewhat different social role from private insurance, which involves a risk portfolio (underwriting) and adjusts premiums according to perceived risk.”

Today Medicare covers more than 50 million people, including most people 65 and older and approximately 8 million younger adults with disabilities. Medicare is not free, nor does it cover everything! Medicare is similar to group insurance or individual health insurance in that it generally pays for acute care and skilled care, not custodial care with two notable exceptions.

The notable exceptions are two limited and very specific conditions:

Medicare Part A pays for custodial care when it is part of hospice care, and

Medicare pays for custodial care in care settings such as home health care, but only if the beneficiary also receives skilled services and meets other criteria such as having a physician’s order for the services and using services provided only by Medicare-approved agencies. Medicare stops paying for custodial care when the patient no longer needs skilled care.

For clarity the following definitions are also important.

Acute Care is a pattern of health care in which a patient is treated for a brief but severe episode of illness, for the sequel of an accident or other trauma, or during recovery from surgery. Acute care is usually given in a hospital by specialized personnel using complex and sophisticated technical equipment and materials, and it may involve intensive or emergency care. This pattern of care is often necessary for only a short time, unlike chronic care.

Skilled Care is a type of intermediate care in which the patient or resident needs more assistance than usual, generally from licensed nursing personnel and certified nursing assistants.

So with the above listed limited exceptions, Medicare DOES NOT pay for custodial (private duty) in-home care unless the senior first needs skilled (medical) care.

What Does Medicare Cover Relative to In-Home Care?

Medicare Part A covers home health care services that include skilled nursing care, physical therapy, occupational therapy, speech therapy, and certain other health care services that patients receive in their homes for the treatment of or recovery from an illness or injury. In these cases, cases associated with these types of skilled care needs, Medicare covers non-medical or custodial (private duty) care needs. Medicare stops paying for custodial care when the patient no longer needs skilled care. Further, Medicare does not pay for long-term stays in nursing homes.

So that’s as clear as I can state the facts regarding Medicare and what it covers relative to private duty home care. I hope it helps. Should you have other questions regarding Medicare and private duty home care, feel free to contact me at kjohnson@visitingangels.com.

Although we provide home care to primarily older adults, we have been of service to other adults over the years. I thought I’d take a moment and give you some ideas that you too might consider as your needs and circumstances arise. Consider 5 unique scenarios and ways in which non-traditional clients have used our services.

JOINT REPLACEMENT. Joint replacement needs can strike at any age, from hip or knee replacements, to torn rotator cuffs. We can help during those first few days or weeks of recovery with bathing and dressing, meal prep and running errands.

ELECTIVE SURGERY. Most men or women who elect to undergo elective surgery desire to do so very discreetly. While close friends and family can provide much needed moral support, they perhaps are not as comfortable providing hands-on help. Let us help during this sensitive process while maintaining your privacy.

WEDDINGS & SPECIAL EVENTS. Mom is coming in town for your daughter’s wedding. Mom doesn’t have the stamina to dance the night away at the reception. A Visiting Angel caregiver would be a wonderful option to keep your mom company in her hotel room.

CHRONIC ILLNESSES. Many adults suffer from chronic and debilitating conditions such as MS and Parkinson’s. Visiting Angels can help provide a break for the spouse or adult child who provides care. Taking a break once a week for a haircut or to have dinner with a friend can be very energizing for the family caregiver.

HOSPICE ASSISTANCE. You have arranged for dad to receive hospice services but you realize they cannot stay long hours with him. You want someone with dad at all times during these last days just to sit quietly and make sure he is comfortable, and to alert hospice if needed Our compassionate, experienced caregivers can be a wonderful support.

With over 12 years of experience in providing home care, we have provided services in conjunction with each of the five scenarios listed above. If you have a home care need that may transition the traditional need associated with older adults, give us a call and let us help.

We wish you and your family peace and happiness throughout the holiday season. The safety and well-being of our loved-ones is always a concern for all of us – regardless of what time of year! However, if you have a senior loved one that is alone over the holiday’s, consider having us spend time with them. Depression is a serious issue for older adults and we can help with companion care and related services. If we can be of assistance in answering questions or providing caregiving services, please don’t hesitate to contact us via the web link on the right panel of this page, or give our office a call at 216.231.6400.

I do hope that 2014 has been a great year for you. As for Visiting Angels, 2014 has been another good year of helping older adults age-in-place with as much independence and grace as possible. We are thankful for the opportunity to serve and help so many older adults with their activities of daily living and providing them with companionship especially at this time of the year. We wish each and every one of our readers a wonderful and prosperous 2015.